If you've been having trouble reaching your doctor lately, maybe you should try hanging out in the blogosphere. The prospect of a $19.2 billion investment in electronic medical records (EMRs) -- the always controversial, not-so-new thing that is supposed to deliver better health care and lower costs -- has driven docs to step into a new digital divide. Some lament product features about EMRs they've known (It won't print. I have to constantly reboot); others get philosophical about the future of medicine (What about privacy?).
Doctors can debate, but it looks as if EMRs are here to stay. The American Recovery and Reinvestment Act states that every American should be provided an electronic medical record by 2014. The Obama administration is looking to speed the transition by providing financial incentives, up to $65,000 apiece to eligible physicians, starting in 2011.
At the most basic, EMRs are digital documentation of a doctor's visit, including patient histories, exam notes, tests ordered, drugs prescribed, and any results. Some systems check for drug interactions, access X-rays, or deliver a prompt when a patient has not had a flu shot. "The preventive aspects alone have saved millions of dollars and thousands of hospitalizations," says Dr. Steve Zeitzew, an orthopedic surgeon at the Veterans Administration West Los Angeles Healthcare Center.
So far, only 17% of doctors use even a basic EMR, and so far, most have had little reason to try. The average primary-care physician, earning, say, $110,000 a year, has no time to research the right EMR system from the 160 certified products out there, and less time to learn how to use it. "The hardware and software will cost you some $50,000," says health-care-IT guru Dr. John Halamka -- he's CIO and dean for technology at Harvard Medical School and chairman of the New England Health Electronic Data Interchange Network, among other roles -- "then 25% of your productivity will disappear as you implement it, patients will complain, and half your office will quit." Worse, if the system does work, the doctor makes less money. "A doctor doesn't get paid for illness she prevents," says Halamka. Cough up money for an MRI machine and the first time you use it, "you get $1,000." Cough up the $50,000 for an EMR system and you get nothing but headaches.
The dream of interoperable EMRs, which would create a mass database where we can detect epidemics and study drug interactions, has yet to be realized. Financial incentives from the government and private insurers may help, but there are other hurdles to overcome. Here are three places to begin.
TEACH THE DOCTORS WELL
Asking doctors to do this on their own is a recipe for disaster. Halamka applauds the regional health-care-IT centers that are outlined in the stimulus bill -- "SWAT teams," as he calls them. "Vendors," he says, "are good at creating products, but not good at implementation, or workflow, or practice reengineering." He cites regional public-private hybrids in Massachusetts and in New York City that have helped deploy hundreds of EMRs.
TAKE OPEN SOURCE SERIOUSLY
The VA's VistA clinical software system, available for free under the Freedom of Information Act, has been a shining example of how EMRs can work. The VA relies on technology developed in-house, so iteration can be slow, but several modified versions exist for non-VA applications. A faster-track solution may be on the horizon. A recent meeting of WorldVistA, a not-for-profit group of VistA developers and fans, focused on creating an open-source collaboration model -- think Mozilla's Firefox -- to make the platform a real alternative to privately developed systems, one to be shared freely.
REALIGN INCENTIVES
The fundamental problem is that doctors get paid for service, not wellness. The ideal is to find real patterns in health, safety, and wellness in EMRs, and reward accordingly. That requires the widespread adoption of a truly interconnected system that doesn't quite exist yet. Even in the widely used VA EMR system, some data are recorded and shared, and some aren't. Once we solve that problem, it will take the determination of all parties -- including the government, through reform to Medicare and Medicaid -- to put in place a new way of paying doctors and health systems.
Related Stories: | Topics:Innovation, Technology, Leadership, electronic health records, EMR, doctor, healthcare, Medical Technology, Health Information Technology, John Halamka, Medicine, Health and Fitness |
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Recent Comments | 10 Total
April 15, 2009 at 2:45pm by Brent Billock
As a further disincentive to doctors, if we get a truly interconnected system for medical records, then patients can go wherever they like for treatment, without the hassle of having records transferred from their current care provider to the new.
April 18, 2009 at 5:49am by Joseph Dal Molin
Thank you for highlighting the open source option as one to be seriously considered. In fact much of the ground work for hitting the ground running with VistA as an option source option has been completed. The work started in 2005 with the Centers for Medicaid and Medicare (CMS) VistA-Office EHR initiative in which WorldVistA won a tender to address CCHIT EHR certification requirements, establishing a support infrastructure and adapting VistA for use in non-VA settings. The focus of the project was to make a high quality, affordable, comprehensive EHR available for the safety net. Based on these efforts and in collaboration with the VistA community, WorldVistA was able to achieve CCHIT certification of WorldVistA EHR in 2007.
The need identified by CMS continues to be of critical importance as a proprietary business model dominated market is creating a digital divide in the ability to leverage EHR for quality improvement and cost reduction. The root cause is high cost and poor track record for innovation, user acceptance and interoperability of products of the legacy software business model in health care. What is needed is an open collaborative approach that is driven by clinical and financial evidence... an evidence base approach to software evolution. We at WorldVistA have been promoting this paradigm shift for eight years now. It is very exciting and encouraging that the government and the health system are increasingly seeing open source as an additional strategic tool to transform the health system.
Joseph Dal Molin
Vice Presiden, WorldVistA
July 23, 2009 at 6:55am by Jason Seoul
Electronic health record systems co-ordinate the storage and retrieval of individual records with the aid of computers. EHRs are usually accessed on a computer, often over a network. It may be made up of electronic medical records (EMRs) from many locations and/or sources. Among the many forms of data often included in EMRs are patient demographics, medical history, medicine and allergy lists (including immunization status), laboratory test results, radiology images, billing records and advanced directives.
EHR systems can reduce medical errors. In one ambulatory healthcare study, however, there was no difference in 14 measures, improvement in 2 outcome measures, and worse outcome on 1 measure.
EHR systems are believed to increase physician efficiency and reduce costs, as well as promote standardization of care. Even though EMR systems with computerized provider order entry (CPOE) have existed for more than 30 years, less than 10 percent of hospitals as of 2006 have a fully integrated system.
Jason Seoul
September 28, 2009 at 11:21pm by Jenny Harding
This seems like a much more efficient way to do things and in the end helpful to most. It's a great example of how we can all work together to achieve more!
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October 1, 2009 at 1:36am by Mike Oswell
Hi, interesting post. I have been wondering about this issue,so thanks for posting. I’ll likely be coming back to your blog. Keep up great writing.
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October 17, 2009 at 1:15am by Komara Arramuse
Very interesting post.
I've been bookmarked on my educations blog
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October 30, 2009 at 5:08am by Liontin Myer
The Electronic Medical Record (eMR) is a multi-year program to replace the paper medical record with an online record which tracks and details a patient's care during the time spent in hospital. The change to working in a digital environment will take place in a number of manageable phases and will be accompanied by support and training for all clinicians. The eMR will significantly improve the delivery and quality of patient care as well as streamline clinical workflow.
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November 3, 2009 at 9:56am by Andrew Eriksen
CCR or a continuity of care record, which is what is used by an EHR system can only reduce medical liabilities and increase efficiency if the adoption and integration rate passes the 70% mark. The sharing of information is the ultimate goal but that is only possible when everyone is using software that can communicate with each other.
EDI or electronic data interchange is critical in the EMR/EHR arena and is the standard form of data transfer used in many key transactions, i.e. bank communications, medical billing.. EDI is only possible when systems have a standard programming language which is why HL7 compliance or integrated solutions are so important. You cannot expect a dos system to communicate with an Apple unless a middle man program is used to make the interface, such as x-link. There is so much that is involved in the transition to EMR and stimulus money is not the answer.
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Andrew Eriksen, CEO
Physician Practice Management Services
http://freeEMRsolution.com EMR Reviews & Free Solutions
http://PhysicianCredentialingServices.com Practice Start Up Assistance
November 5, 2009 at 1:35pm by Eric Sandler
I think Obama is really keen in extracting data and making it available online.
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November 21, 2009 at 6:04am by Anisa Cikal
great post, thanks a lot for that.
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